Abstract
Behavioral health disability claims have been reported more frequently over the past several decades (Warren, 2009). This has led professionals to question whether there is an actual increase in actual behavioral health disorders or if there are other issues that are driving this increase (American Medical Association (AMA), 2008; Gatchel & Schultz, 2005; Melhorn & Ackerman, 2008; Reed Group, 2009; Work Loss Data Institute, 2008).
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- 1.
Behavioral health disability in the contexts of workers’ compensation and personal injury law is discussed in detail elsewhere in this volume and will not be discussed here.
- 2.
Statute of limitation issues may complicate workers’ compensation claims initiated after mental health disability coverage periods have run out.
- 3.
Moreover, true psychological concerns can cause impairment in functioning and require professional treatment to ameliorate. On the other hand, psychosocial concerns are issues that are likely to occur with most people in life. Examples of psychosocial concerns are job dissatisfaction, workplace conflict, and work performance issues, to name a few (Warren, 2013a, 2013b).
- 4.
Although the majority of physicians are members of the American Medical Association, rarely does a physician follow the AMA’s Guides to the Evaluation of Permanent Impairment (6th edition, 2008). The Guides provide professional instruction to other professionals as well who profess to evaluate and treatment individuals with impairment in functioning. Chapter 5 provides detailed information regarding the appropriate evaluation of individuals with behavioral health disability concerns. Case managers should obtain training in the appropriate utilization of the methods discussed in the Guides. By doing so, this will help the case manager to better understand the fundamentals of appropriate professional evaluation of impairment in functioning.
- 5.
Although a signed release is not technically required under the federal Health Insurance Portability and Accountability Act (HIPAA, 1996), other state mental health laws may supercede the HIPAA law. Most behavioral health professionals are instructed by their professional organizations to follow the more restrictive law in order to provide protection to their patients/clients. Thus, although the case manager may send a signed release, the treating professional may not honor the insurer’s release. This leaves the case manager in the difficult situation of trying to obtain information from the treating professional to make an initial decision regarding the behavioral health disability claim.
- 6.
Testing that cannot be utilized for specific reasons related to the testing process.
- 7.
See Sect. 13.4.12.
- 8.
With behavioral health disability claims, when a psychosocial concern arising from work is the primary catalyst for filing for disability, it is important to recognize that this represents a belief by the claimant that s/he must be completely satisfied with one’s job or that one will never experience any workplace conflict. With changes within the workplace, it is highly likely that one will experi- ence job dissatisfaction or conflict at some time during one’s employment (ACOEM, 2006). Instead, it is the claimant’s coping style that comes into play in these situations. Coping style is shaped by a number of aspects, for example, childhood upbringing, stress management tech- niques, social support, and one’s personality.
- 9.
An example of contradictory information that Warren and Hubbard (2008a) noted was when a claimant who was a customer service representative was diagnosed with Major Depressive Disorder. The treating professional noted that the claimant was not able to perform her job due to an inability to concentrate and interact with the customers or to respond to their requests for assistance in resolving concerns. The claimant was described as being unable to cope with a full day’s work and could not manage many activities of daily living, such as traveling in a car, paying bills, or preparing meals, among some of the noted limitations. When the submitted documentation was examined, it was found that the claimant was a single mother with children less than 10 years of age. One child needed to have prescribed medications given at specific times. It was the claimant’s responsibility to ensure this occurred. Of significance, the claimant was completely responsible for caring for herself and her children on a daily basis. The treating professional reported that the claimant was unable to concentrate sufficiently to answer customer calls and unable to complete most activities of daily living. Clearly, this is at odds with what the claimant was actually doing. She was able to care for herself as well as her children, including ensuring that prescribed medication was taken at appropriate times by her child. Moreover, the treating professional also went on to note that the claimant was able to drive a vehicle. The inherent problem with the treating professional’s assertion is that driving is an activity that requires complex functioning across multiple cognitive domains, including sustained concentration and attention, visuospatial skills, and short- and long-term memory. Consequently, because driving a vehicle requires similar cognitive skills to those in the workplace, it is unlikely that the claimant was not able to function in the work setting with lesser demands, but could function in driving a car, which takes multiple cognitive skills.
- 10.
When the claimant is out of work and additional factor may create noncompliance, the claimant may no longer have insurance to provide the recommended care. If the claimant wished to have insurance after one’s employment terminates, one must obtain it for oneself. Such insurance is typically covered by the Consolidated Omnibus Budget Reconciliation Act (COBRA , 1985). COBRA had allowed employed people and their families to opt to continue to receive group health benefits that are provided by their current group plan. This is typically for a limited period of time (18 months). The costs associated with COBRA are quite high. For example, those who are qualified are usually required to pay the entire healthcare premium to 102% of the cost of the plan. This can result in another form of noncompliance due to the claimant’s inability to pay for ongoing treatment, diagnostic procedures, and medications. However, with the institution of the American Recovery and Reinvestment Act of 2009 (ARRA) , an individual who is eligible for assistance will pay only 35% of the premium needed to obtain COBRA coverage. Thus, this change should help to ameliorate some of the financial burden and serve to remove one barrier to noncompliance.
- 11.
See discussion of malingering in Sect. 13.4.10.
- 12.
Also sometimes referred to as “symptom magnification.”
- 13.
The DSM-5 (ApA, 2013) noted malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.” Moreover, there are four specific criteria that must be met before malingering is reported by the professional. Aronoff et al. (2007) completed an extensive meta-analysis and found specific behaviors and concerns associated with malingering. In general, the more of these that were identified, the more the potential for malingering is raised. In addition, Iverson (Iverson, 2003, 2007) reported additional factors that serve as catalysts for symptom exaggeration and malingering.
- 14.
Talmage and Melhorn (2005) wrote a book for physicians regarding the RTW process. They noted three primary constructs in looking at an individual’s ability to work. These constructs are:
-
1.
Risk: This is defined as the potential of harm to the individual or others, if the individual engages in a type of specific work.
-
2.
Capacity: This is in regard to the physical, mental, and psychological ability to perform the specific tasks of the job.
-
3.
Tolerance: This is noted to be the individual’s ability to tolerate the specific activity, such as work.
-
1.
- 15.
While HIPPA technically does not cover workers’ compensation claims, treating professionals routinely demand HIPPA compliance measures to ensure that they limit their liability exposure.
- 16.
There are several available guidelines. The most commonly used are the case manager process of the Work Loss Data Institute’s (2008) Official Disability Guidelines (ODGs), the Reed Group’s (2009) Medical Disability Advisor (MDA) and MDguidelines which are complementary, the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 6th edition (2008), and the American College of Occupational and Environmental Medicine’s (ACOEM, 2008) Practice Guidelines.
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David Hubbard, J., Warren, P.A., Aurbach, R.M. (2018). Case Management and Behavioral Health Disability. In: Warren, P. (eds) Handbook of Behavioral Health Disability Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89860-5_13
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